Conversion from tacrolimus to cyclosporine--a based immunosuppression following liver transplantation.

Cataldo Doria, Ashok Kumar B Jain, Victor L. Scott, Salvatore Gruttadauria, Ignazio R. Marino, Howard R. Doyle, John J. Fung

Research output: Contribution to journalArticle

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Abstract

We examined the frequency, reasons and outcome after conversion from Tacrolimus to Cyclosporine A. From August 1989 to December 1992, 1000 consecutive liver transplantation patients were studied, which included 834 adults (age>18 yr.) and 166 children with mean follow-up of 77 months (range 56 to 96). A prospectively populated electronic database was queried to identify patients that underwent conversion, the clinical indication and outcomes. Thirty-seven out of 834 adult recipients (4.43%), mean age of 48.4+/-12.9 years, 19 male (51.35%) and 18 females (48.64%) required conversion from Tacrolimus to Cyclosporine A baseline immunosuppressive therapy. No pediatric patient required conversion. The mean time interval from liver transplantation to Cyclosporine A conversion was 443.45+/-441.44 days (range 22 to 1641). The clinical indications for conversion included: 20 neurological (54%), 6 gastrointestinal (16%), 5 hematological (14%), and 6 other (16%) scenarios. Seven of the 37 patients (18.9%) died. The causes of death were multi-organ failure (2), sepsis (2), pancreatitis (1), hepatic failure due to relapse of ethanol abuse (1), and unknown cause (1). Nine out of 37 patients (24.32%) had to be reconverted to Tacrolimus (mean 282.22+/-499.79 days; range 15 to 1583 day with a median of 135) after institution of Cyclosporine A; none showed recurrence of the original symptoms. The reasons for these re-conversions were acute cellular rejection (44%, n=4), chronic rejection (11%, n=1), increased hepatic enzymes (33%, n=3) and progressively worsening neurological symptoms (11%, n=1). The frequency of conversion from Tacrolimus to Cyclosporine A was 4.43%. Conversion is safe and efficacious if done in a controlled setting. Additionally, re-conversion to Tacrolimus for lack of efficacy of Cyclosporine A did not appear to be associated with a recurrence of the condition that caused the initial switch.

Original languageEnglish
Pages (from-to)48-55
Number of pages8
JournalExp Clin Transplant
Volume1
Issue number1
Publication statusPublished - Jun 2003

Fingerprint

Tacrolimus
Liver Transplantation
Immunosuppression
Cyclosporine
Recurrence
Liver Failure
Immunosuppressive Agents
Pancreatitis
Cause of Death
Sepsis
Ethanol
Databases
Pediatrics
Liver
Enzymes

ASJC Scopus subject areas

  • Transplantation

Cite this

Doria, C., Jain, A. K. B., Scott, V. L., Gruttadauria, S., Marino, I. R., Doyle, H. R., & Fung, J. J. (2003). Conversion from tacrolimus to cyclosporine--a based immunosuppression following liver transplantation. Exp Clin Transplant, 1(1), 48-55.

Conversion from tacrolimus to cyclosporine--a based immunosuppression following liver transplantation. / Doria, Cataldo; Jain, Ashok Kumar B; Scott, Victor L.; Gruttadauria, Salvatore; Marino, Ignazio R.; Doyle, Howard R.; Fung, John J.

In: Exp Clin Transplant, Vol. 1, No. 1, 06.2003, p. 48-55.

Research output: Contribution to journalArticle

Doria, C, Jain, AKB, Scott, VL, Gruttadauria, S, Marino, IR, Doyle, HR & Fung, JJ 2003, 'Conversion from tacrolimus to cyclosporine--a based immunosuppression following liver transplantation.', Exp Clin Transplant, vol. 1, no. 1, pp. 48-55.
Doria, Cataldo ; Jain, Ashok Kumar B ; Scott, Victor L. ; Gruttadauria, Salvatore ; Marino, Ignazio R. ; Doyle, Howard R. ; Fung, John J. / Conversion from tacrolimus to cyclosporine--a based immunosuppression following liver transplantation. In: Exp Clin Transplant. 2003 ; Vol. 1, No. 1. pp. 48-55.
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